This week, Unison Scotland launched their alternative strategy for a National Care Service in Scotland, in response to the Scottish Government’s bill which at time of writing remains paused.
Produced by the Manchester-based Association for Public Service Excellence (APSE), the report aims to ‘make the case for the direct public delivery of social care and maps out the first steps that can be taken to achieve this’.
While we’re happy to see the release of the report at such a crucial time in the campaign process, we believe this is just the first step in bringing about a more thorough discussion on the specifics necessary to ensure a National Care Service in Scotland is effective and beneficial for those who need it.
Primarily, we welcome the report’s call for the removal of private profit extraction from social care in Scotland. Private equity firms which funnel profits into overseas accounts and assets are bleeding the Scottish economy dry, with an estimated 20% of social care revenue winding up leaving the local economy in this way. The report claims:
(1.9) A major expansion of publicly owned and operated provision, capitalised through publicly owned and operated provision, capitalised through public borrowing, could counterbalance the private, resource extraction-based model by creating a financially transparent alternative to the private market.
The concept of making profit extraction less appealing is of course welcomed, particularly with an adequately funded public service of a high enough standard as to disincentivise new, private investment. However, only by eliminating the possibility of profiting from social care, dismantling the private, for-profit market for social care in its entirety, can we ensure this standard is delivered. The report never goes as far as to call for the nationalisation of social care, but we do recognise this is a process which cannot happen overnight, and so progressive steps towards introducing this to the mainstream debate are promising.
(1.29) It is at the local level, whether led by Integrated Joint Boards/Care Boards, local authorities, or the NHS, that rebalancing of provision should take place, but the NCSS offers potential for this to be driven by a National Strategy.
Recognition that local control is imperative for the functioning of an effective care service here is encouraging. However, as we have previously written on the risks of the creation of centralised care boards and bureaucratic Integrated Joint Boards (IJBs), we echo Unite’s concerns that this could be seen as a “power grab” by central government. Only locally ran and locally resourced services, with effective financial backing and minimal intervention from central government, can effectively meet local needs, which vary wildly across the country. Only people in the Highlands and Islands are acutely aware of how to deliver care that meets the needs of people in the Highlands and Islands, and these will of course be different to how care needs are met from Glasgow to Galloway, and from Aberdeen to Argyll.
Furthermore, the risk of a National Care Service being seen as ‘secondary’ to the NHS is a natural consequence of the nature of integrated services suggested here. The NCS and NHS must be two collaborative but independent services, as we have previously reported, with open and clear channels of communication to meet the needs of service users most effectively.
(1.26) Bringing care staff into the employment of councils or the NHS would improve rates of pay and working conditions and give access to decent pensions. The private sector would have to respond to remain competitive but with more public provision available, pressure to increase fees would be lessened.
Again, we strongly encourage that social care staff brought in through a new, fully resourced national service be under the employment of local authorities to maintain the necessary degree of separation between the aims and resources of the NCS and NHS. This will also ensure a high and equitable standard of pay and conditions for workers across the board, and provide a level playing field for collective bargaining if and when it is necessary, thereby eliminating the need for the pressure of private interests to drive standards.
(3.2) … [The Feeley Review’s] recognition that, to be on par with the NHS, social care must be provided on a needs-driven basis is highly significant. It goes to the core difference between the way that health and social care must be provided on a needs-driven basis is highly significant. It goes to the core difference between the way that health and social care are delivered; access to free at the point of delivery health care is a universal right, whereas access to social care is rationed through variable eligibility criteria.
A nationalised social care service, in order to be a preventative service which offsets the increasing public costs of running the NHS, must be a universal right, as is emphasised in the report, and free at the point of need, not the point of delivery. Only by enshrining this as a principle in a comprehensive care service can we ensure its preventative nature.
We are greatly encouraged that the APSE recognises the crucial role of local powers in delivering a better resourced care service, the imperativeness of removing private profit extraction, and that Unison Scotland are backing both. However, it now needs to go further.
Common Weal, in full solidarity with Unison Scotland’s campaign, and others across the health and social care sectors, calls on the Scottish Government to scrap the current National Care Service (Scotland) Bill in its entirety, in order to step back, reassess, and take into consideration our proposals for a localised service which is free at the point of need. You can download a free copy of Caring For All, our blueprint for a National Care Service, here.